Tuesday, January 30, 2018

Larry Nassar
should spend the rest of his life in a place where he is unable to have contact
with children and teenagers. Whether one approaches this case from a
criminological or clinical perspective, experts agree that Nassar’s behavior
was brazenly predatory, incredibly harmful, but both unique and typical at the
same time. In this week’s blog, we discuss the Nassar case, what we can learn
from it, and how we can do better.

Nassar is unique
in several ways. First, his position was one of privilege and he utilized this
position as a means to sexually abuse patients in his care, often while other
people were present in the room. He is
also atypical because of the sheer number of people he harmed, the high-stakes
role he played in their lives, and the size and scope of the venues in which he
operated. There is no doubt about it, listening to the testimony of those he
victimized, illuminates the level of trauma and pain caused by Nassar’s
actions.

At sentencing, the
judge in this case told Nassar that she had signed his “death
warrant”, although some have expressed
concern about this and other actions that took place in court.Clearly, it is essential that we listen to
the stories of each person that Nassar harmed. We need to validate their
experiences and their pain. Many have applauded Judge Rosemarie Aquilina for
her treatment of each person who wanted to give an impact statement. However,
questions about whether Aquilina was impartial in the sentencing of Nassar
remain. We agree that judges are entitled to their own opinions, as we all are,
but we argue that the judiciary and the overall legal system must remain
impartial. In this case, the vocabulary and intention behind Judge Aquilina’s
statements were not neutral; they were loaded, and therefore problematic. While
we can all agree that Larry Nassar should receive a prison sentence for his
offenses and that the sentence should reflect the severity of his crimes, the
judgement should be unbiased, appropriate and considered. By suggesting that
she was signing his “death warrant” Judge Aquilina was not being neutral.

In addition, we
must consider other variables before we make the statement that Nassar should
never get out of prison. We should further question whom the best person is to
make such decisions. Is it the court? The judge? Sentencing guidelines? Sex
crimes experts? A range of other professionals? Judgements in court and the comments given by Judges
when sentencing are important as they can have long lasting consequences for
the victims, their families and the convicted person (as demonstrated by the release
of John
Warboys in the UK); therefore care, consideration and neutrality are very
important. A major question is what we can learn from this case to prevent
future abuse; so far, the media has not addressed this with the same fervor
that they have in their coverage of the trial.

From a clinical
perspective, there are fundamental questions about what we can learn from
Nassar. In some ways, his patterns of behavior are well-known. By all
appearances, his actions were carefully planned and purposeful. He possessed
expertise at gaining the trust of these young women and those around them.
Unlike many (perhaps most) people who break the law, he does not appear to have
been impulsive or reckless in his modus operandi. Ironically, his apparent
self-management skills actually argue that he could be kept safe under strict
community supervision more easily than others who are clever but do not think
before they act. Likewise, his age, verbal abilities, and interpersonal skills
make it likely that he could participate effectively in treatment.

While these last
points may seem contrary to the sentiments of most who feel that Nassar should
simply be punished, they address key concerns in the way forward for Nassar.
Many who have experienced sexual violence want the person who harmed them to
understand and come to terms with what they have done; effective treatment can
do this and be of assistance to those who have been victimized. An unfortunate
reality of life in prison is that it can be too easy simply to enter what is
known as the “psychological deep freeze” where one lives moment to moment
without regard to the past. Others who have been victimized want those who
abuse to get help and stop the behavior. Treatment programs can be more
effective in this regard than prison. Whatever one’s immediate beliefs about
the proper response to sexual violence, the needs of survivors can be more
nuanced than the desire to “throw away the key.”

From a
criminological perspective, it is crucial that we recognize that life in prison
goes against the key components of incarceration – people who are incarcerated
go to prison as punishment and
prepare for release during incarceration through education, treatment, and
reentry supports that they need to successfully integrate back into society. With Nassar it has been determined from the
outset that he is beyond redemption and therefore should not engage with
anything while in prison, including treatment or rehabilitation.

In addition, we
understand that both general and specific deterrence offer little in terms of
prevention. First, punishment on its own does not and cannot address the
underlying etiology of Nassar’s behavior. Perhaps more importantly, believing
that punishing Nassar to a lengthy a prison term somehow shows others that they
should not sexually offend is naïve.Decades
of research attest to these facts.

Most
importantly, while this particular case revolves around one man and the trauma
perpetrated by his hands, we must remember that sexual abuse, especially of
this nature, does not happen in a vacuum. What happened in this case was an
institutional failure of epic proportions, not unlike what we have seen in
other institutions where abuse was rampant. Abuse of this magnitude can only
happen when others turn a blind eye. Ongoing investigations are under way to
find out what others knew and what actions they did and didn’t take. What this
and other cases show is that those who turn a blind eye to abuse come from all
backgrounds and are not limited to one gender or age group.

Larry Nassar
should spend the rest of his life behind bars. His behavior caused undeniable
harm to over 150 girls in his care. The majority of these girls spoke at
sentencing. We heard their voices and the court validated their experiences in
a watershed moment that most people who experience sexual abuse never get. This
validation offers an enormous step toward healing, but healing doesn’t end with
Nassar behind bars. If we believe that justice comes only from a long prison
sentence, we are sadly mistaken.

Thursday, January 25, 2018

Tarana Burke first used the
term “Me Too” to 2006 to elevate the conversation around sexual violence. The
conversation around the ubiquitous nature of “sexual misconduct” came to a head
in late 2017, when Alyssa Milano tweeted that anyone who has been sexually
assaulted or harassed should reply to the tweet with “Me Too”. This marked a
changing tide that empowered individuals who had experienced any form of sexual
misconduct to speak up. We should celebrate the fact that so many people have
found their voice and are willing to share their story. We should also
understand the nuances inherent in the movement which is a debate involving feminism,
equality, collaboration, and interventionism as well as sexual abuse,
harassment and victimization. Each of these areas have seen long standing
battles being fought on many fronts, therefore it’s important to realize that
#metoo has not come out of nowhere.

We must recognize that
there are many forms of harassment, and that the impact, consequences, and
legacy of harassment change with the individual people in question. Like sexual
violence, harassment does not take the same emotional, psychological, and
behavioral responses toll on those affected by them. While recognizing the that
we cannot dictate the impact of sexual harassment, we must recognize that while
all sexual harassment, sexual abuse, and sexual assaultcarry an unacceptable risk of harm, they are
not the same thing. We can honor the voices, stories, and pain that stem from
all forms of misconduct, while also recognizing that, perhaps, they are parts
of different, but equally important conversations. Therefore, we need to think
about context, situation, personality, resilience, and support in all cases.

This past week, the website
Babe.net, which uses the tagline
“babe is for girls who don’t give a fuck”, published an account of an alleged
nonconsensual sexual interaction between a young woman named “Grace” and
comedian Aziz Ansari. A few days after the Babe
account was published, Ansari responded. In part, he stated that he believed
that the encounter was completely consensual and that when he heard this was
not the case for her, he was surprised and concerned.

Some are calling the Babe account nothing short of “revenge porn”. Importantly, the published
account has sparked debate about what constitutes sexual assault vs. a “bad
date”. Perhaps this is the wrong conversation. Perhaps this type of
conversation is what keeps people stubbornly in their silos, screaming over one
another, or passionately stating that this is a “war to be won”. In addition to this we need to
continue to think about what we pay attention to in respect to consent, because
we often think in terms of recognizing verbal cues, but what about non-verbal
cues (i.e., a change of tone, silence, different body language, etc)? Quite
often we look to hear “no” or “stop” rather than recognizing disengagement, a
change of tone or a lack of interest.

It is true that the #metoo
movement has sparked debate, as well as dialog. It has opened doors to
conversations and disclosure that otherwise would have remained unheard and
unaddressed. Sadly, movements like this will not end sexual victimization.
Calling people out and shaming them for their behavior does not change that
behavior if there is little to no understanding about what the wrongdoing
is.Calling attention to the issue does
not prevent the issue from occurring. Education, connection, and mutual
understanding will cultivate a shift toward prevention. We need to change the
conversation, we need to start it earlier and use a different means to have it.
We need to think about how we educate children, families, peers and communities
more effectively. In addition, we need to look at the narrative coming from the
media and what TV, Film and the press say about these issues.

Were Ansari’s actions
potentially harmful? Yes. Did Grace provide verbal and non-verbal cues that she
wanted to stop the sexual activity? Yes. Does that mean Ansari understood those
cues? No. This is where the conversation needs to shift.

So often, we hear young
people, particularly young men, stating that they thought sexual activity was
okay because, “she didn’t say no”. Our conversations about consent must go
beyond the fact that not saying no does not mean yes. One way to shift the
conversation to help young men understand this better is to talk openly about why someone might not say no.

In the end, however, it is
our fervent hope that the #metoo dialog will move beyond those most immediately
affected by harassment and abuse and include marginalized populations. After
all, rates of abuse and harassment in and around marginalized and
underprivileged communities, including Native American and other ethnic
minority communities. Likewise, LGBTQ people experience higher rates of sexual
violence. Conversations within and between these communities must be elevated
in the conversation. If we are ever to truly approach sexual violence and
harassment as a public-health issue, these voices need our attention as well.
Hatred and vitriol get us nowhere.

Campus sexual assault
(CSA) has received unprecedented attention over recent years, resulting in an
abundance of federal guidance and mandates. In response, efforts to address and
prevent CSA at Institutions of Higher Education (IHE) across the country have
grown quickly, including the development and implementation of programs and
policies. Because the changes on campuses have occurred at such a rapid pace, a
number of gaps exist within the field of CSA research. To ensure that changes
on IHE are evidence-based, there is a need to review the existing research
available and the inquiry still needed based on key areas outlined in federal
guidance, the expressed needs of campus community members, survivors, and
students who commit sexual offenses on college campuses. The purpose of this
review is to summarize the empirical research related to CSA gained from the
past two decades and identify areas in which further work is needed,
specifically related to key areas identified in recent guidance provided to IHE.
This article concludes with guidance for research moving forward to help
strengthen response and prevention efforts.

Could you
talk us through where the idea for the research came?

There are
a few reasons that motivated this article. First, while the topic of Campus
Sexual Assault (CSA) is not new, the attention provided to the issue has been
elevated in recent years. This is due to a number of factors, including student
activism as well as federal mandates and guidance.The Obama-Biden Administration identified
campus sexual assault as a priority issue, and convened a task force which
issued a report in 2014 that has served as a primary document for providing
guidance.Although many institutions of
higher education have embraced the call to action to better address CSA, the
research in terms of best practices lags.

Second,
the timing in our culture is ripe to further address CSA. The current time
period provides a unique window where universities and colleges are finally
addressing CSA and there is accountability demanded by students, families, and
the public. Clearly, the #MeToo movement continues to shine a light on the
issue of sexual violence and it appears to be a “watershed moment”. This
presents an opportunity for researchers to engage in work to help develop the
evidence-base for the implementation of practices, programs and policies that
will be meaningful and impactful.

In
addition, it is clear that one of the major gaps in the field relates to
research on students who sexually offend. There currently lacks information
about the predictors of offending within this group, their trajectories, and
best practices for intervention and prevention efforts.The discussion about these gaps at the ATSA
conference in 2016 and learning from others in the field was also a motivation
for writing this article, as there is clearly a need for those who work with
individuals that commit sexual offenses to contribute to our body of evidence
on CSA.

What
kinds of challenges did you face throughout the process?

The most
challenging part of the process was trying to funnel the massive scope of the
issue into a manageable and organized manuscript.The field of sexual violence prevention is
wide and complex, and research in this area is relatively new so there are numerous
gaps that need to be addressed.We used
the guidance provided in the Obama Administration’s Task Force to Protect
Students from Sexual Assault as our organizing structure.They addressed a number of different
policies, practices, and programs that need to be implemented at institutions
of higher education, yet the field has not caught up with having solid
evaluation to help inform these efforts. I was also fortunate to work with an
excellent team of researchers to help review the literature from the field as
our foundation.

What do
you believe to be the main things that you have learnt about campus sexual
assault?

It is an
exciting time for those who work in the field of CSA because of all the changes
occurring, but writing this article clearly illustrated the gap between
practice and research.At this point,
there is a push for institutions of higher education to move quickly to address
CSA which is obviously a good thing, but research has not kept the same pace
and therefore we are in real need of rigorous studies that examine a wide range
of CSA policies, programs , practices and prevention efforts.

Through
writing this article, I appreciated the opportunity to learn more about those
that work with individuals who commit sexual offenses.Of the many areas needing research related to
CSA, figuring out how to better work with students who offend appears to be
critical and severely lacking. I am hopeful, however, that those who have
conducted research on sexual offenders more broadly will be interested in
bridging their work onto college campuses, as their expertise is needed and
would make an important contribution.

Now that
you’ve published the article, what are some implications for practitioners?

I think
that good research-practitioner partnerships are invaluable.Within the arena of CSA, the development of
these partnerships seems essential.The
research needs to be informed by what is happening in real time and on the ground,
and it would be best if these practices were informed by evidence.I would encourage both researchers and
practitioners to seek each other out to figure out how to collaborate to
address the many issues needing attention within the field of CSA.

Thursday, January 11, 2018

A recent BBC documentary highlights
the work of a school in Glasgow, Scotland, to help young school children manage
their aggressive behaviors. On its surface, the video is inspiring: with little
to no resources, a group of dedicated teachers and behavior specialists design
“nurture rooms” where these children can get specialized attention and
guidance. This approach reduces the use of empty “time-out rooms” where adults
sit with children who have no choice but to stew in their own challenges. The
video ends with questions about how best to fund similar programs in the
future. It can’t be easy; even the “comments” section of the video highlights
the attitudes of many in the public. One viewer states, “A boy’s ears are in
his backside. Bring back corporal punishment.”

Interestingly,
89% of the teachers in the video state that they blame the parents for their
children’s behavior. There is no discussion of the ways in which the school
environment itself may contribute to the children’s problems. Perhaps most
revealing is that there is no mention whatsoever of the fact that many of these
children likely have histories of adverse and traumatic experiences. It’s as
though the same schools that would build handicap access for children with
physical disabilities would not make similar accommodations for young people
with the less obvious disabilities that can arise from growing up in adversity.
Under these circumstances, blaming parents is perhaps less helpful than
examining the broader
context in which abuse and adversity occur. Parents should, of course, be
held accountable for their actions. However, helping prevent further harm means
understanding adversity and assisting people in moving beyond it.

These are not
simply ideological statements. Research on complex
trauma and aggression in secure juvenile justice settings – the obvious
next step for the young people in the BBC video – by Julian Ford and his colleagues
describes the extraordinarily high rates of traumatic experiences in the
backgrounds of incarcerated youth and
the connection between formative events and future aggression. The study
describes interviews with clinicians treating 40 youth who had perpetrated sexual
abuse, finding that 95% of them had at least one traumatic experience in their past
and that 65% of them met the diagnostic criteria for Post-Traumatic Stress
Disorder. The clinicians viewed traumatic experiences as having set into motion
the sex crimes of 85% of these youth. In other words, while many in the general
public may see only the backsides in need of corporal punishment, a deeper
examination of these youth reveals a much more disturbing truth. It should be
no surprise that punishment-only
responses don’t work.

Even among
adults, it can be easy to overlook the amount of trauma and adversity in the
backgrounds of men
and women who
sexually abuse. Levenson, Willis, and Prescott (2015; 2016) found elevated
rates of adverse experiences (including over 13 times the odds of verbal abuse)
in the backgrounds of these individuals. As lawmakers and the lay public talk
about getting ever tougher on crime in the name of assisting victims, it’s easy
to miss seeing how many of those who have abused have themselves been
victimized. Indeed, the deeper one digs into research on people who abuse, the
clearer it is that the forces driving abuse cannot be easily dismissed by
statements such as “they should have known better.” As many have said before, recognizing
abuse as a public health issue rather than simply trying to punish it away will
be a good start.

In the
“flashbulb moment” that comes in the immediate wake of abuse, it is easy –
perhaps even natural – to experience the desire to destroy both the abuse and
the abuser. Likewise, it can be easy for prison officials, supervising agents,
and treatment providers to view irritating features of those in their charge,
such as irritability, hypervigilance, emotional numbness, and apparent memory
problems as efforts to avoid responsibility when they are also diagnostic
criteria for PTSD. The real questions for all professionals include: How can we
best understand the totality of our clients’ experiences and not simply view
them as merely the sum of their worst behaviors? Can we stay true to our
mission of assisting those who have been abused by including those who have
also abused others? Can we go beyond holding people accountable and also teach
them about accountability? Can we exercise the same compassionate working
alliance (central to all of the world’s religions and successful forms of
psychotherapy) with people whose actions can seem separate from their
histories? Ultimately, can we accept the person in front of us even as we don’t
accept abuse?

Understanding
trauma in the lives of others has been a difficult undertaking in mental health
practice since the time of Freud.
Just the same, human beings have helped one another move forward from trauma as
long as there have been traumatic experiences. Not everyone who has been
traumatized needs specific treatment, but it seems that the majority of those
who might be inclined to cause harm can benefit from trauma-informed care.

Friday, January 5, 2018

The start of a new year is often
a time of reflection and hope. We think about our experiences as well as
practice over the last year and learn from poor practice as well as build upon
good, existing practices. Having a solid, reliable, evidence base is central to
all aspects of life, personal and professional!

Thinking back over the last 12
months, 2017 has been an interesting year to say the least with the common
factor being one of ideology and “common sense” understandings winning out over
an established evidence base many times. A recent example was the United States’
Centers for Disease Control emphasizing that it would not accept funding
submissions that contain words such as “evidence-based”, “transgender”, etc. Although
we all have ideologies, thoughts, and beliefs that govern our lives and
practice, the majority of the time these are not based on facts, outcomes and
analysis. Rather, these can be based on perceptions and collusion with friends,
family and/or peers. This might be fine if we are deciding which diet to use,
airline to fly or coffee shop to visit; but, are these the best metrics for
deciding on larger, societal scale decisions? All too often it seems that we
agree with science primarily when it supports our views.

This reliance on ideology has
often times led – especially in northern hemisphere westernized countries – to
a rejection of expert knowledge as well as evidence. In 2017, in our opinion,
this resulted in a return to lay knowledge and ideologically driven theories,
policies and practices. In other words, sometimes going backwards to debunked beliefs and
practices!

Let us be clear here: we are not
being elitist and saying that expert knowledge is the only way to develop
policies and practices, because it is not. Instead, we are saying that in order
to develop best practice we need to listen, to hear, and to understand all the
voices in the debate without shutting any down. The transition away from
evidence based policy and practice is worrying because it means that we are not
listening to all the available information and are basing our ways of working purely
on ideology. We want our taxes spent appropriately and we want governmental
decisions to be realistic, appropriate and fit for purpose. We should want
evidence based decisions, policies and practice! Why? Because it means that we
are not spending time, money and resources blindly or causing harm along the
way; we have an idea of what works and what does not work, therefore we can be
more measured and realistic in terms of social, political, practice and policy
change.

However, in many current northern
and western hemisphere countries with right wing, or at least right-leaning,
governments’ evidence is not the metric that they want to use in their policy
and practice shifts, they want it to be ideological. Clear examples of this can
be seen in the UK (via Brexit). Clear examples also abound in the USA. The best
example is perhaps the election of Donald Trump during a year of campaigning
not known for its reliance more on ideas than on evidence. Other examples
include changes to Obama-care (which many people have found undesirable, but
which provided millions of people access to healthcare), refusal for the CDC to
fund research from transgender issues and the effects of gun violence, and
defunding of the National Registry of Evidence-Based Programs and Practices).

In the field of sexual abuse,
evidence based practice is central and needs to remain central. We have seen
the cost and consequences of ideologically driven policies and practices on the
ground, from funding of policies that don’t reduce risk (e.g., public
registries and residence restrictions) to increasingly scarce funding for those
that can reduce risk (e.g., treatment and supervision). As one example, in the
state of West Virginia, probation officers specializing in supervising people who
have committed sex crimes have lost
their jobs at the same time as the state’s Supreme Court justices spent
astronomical sums on office
furniture.

Evidence tells us, if we do
research well and in the most appropriate way for the question at hand, we can
discern what works and what does not. Sometimes we don’t like what the research
tells us and sometimes we do. Despite the outcomes of research the most important thing is that, whether we
like it or not, we are called as professionals to do what actually works!

Kieran McCartan, PhD

Chief Blogger

David Prescott, LICSW

Associate blogger

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The Association for the Treatment of Sexual Abusers (http://atsa.com/) is an international, multi-disciplinary organization dedicated to preventing sexual abuse. Through research, education, and shared learning ATSA promotes evidence based practice, public policy and community strategies that lead to the effective assessment, treatment and management of individuals who have sexually abused or are risk to abuse.

The views expressed on this blog are of the bloggers and are not necessarily those of the Association for the Treatment of Sexual Abusers, Sexual Abuse: A Journal of Research & Treatment, or Sage Journals.

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